Apparatuses and methods for transcleral cautery and subretinal drainage

ABSTRACT

Apparatuses for transcleral cautery and subretinal drainage are provided. One such embodiment includes a barrel section, a needle section extending from the barrel section, and a scleral depressor section at least partially surrounding an intermediate portion of the needle section. A cautery section may also be defined between the scleral depressor section and the distal end of the needle section. Methods are also provided.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority to the copending U.S. provisionalapplication entitled “Retinal Inserted Drainage/Cautery Apparatus,”having Ser. No. 60/276,068, and filed Mar. 15, 2001, which is entirelyincorporated herein by reference.

TECHNICAL FIELD

The present invention is generally related to retinal surgery and, moreparticularly, is related to apparatuses and methods for transcleralcautery and subretinal drainage.

DESCRIPTION OF THE RELATED ART

In retinal surgery, for example to treat a retinal detachment condition,the time-honored approach to subretinal fluid drainage is a scleralcut-down from outside the eye (“ab externo”) making an opening largeenough to visualize and cauterize the choroid. The scleral cut-down andthe resulting large opening in the sclera are known as a sclerotomy. Inthis procedure, choroidal cautery (i.e., burning or searing of apenetrated portion of the choroid) is performed to minimize hemorrhagefrom the choroid. Typically, a small needle attached to a tuberculinsyringe with the plunger removed is then inserted through thesclerotomy, through the cauterized choroid, through the retinal pigmentepithelium (“RPE”), and into the subretinal space containing thesubretinal fluid (“SRF”). The positive pressure of the eye and capillaryaction results in the SRF passing from the subretinal space through theneedle into the tuberculin syringe and, therefore, out of the eye.

To save time associated with the foregoing procedure, many surgeonsbegan performing a different procedure. In particular, a small needleattached to a tuberculin syringe with the plunger removed is inserted abexterno directly through the sclera, i.e., without first making asclerotomy. The needle then is passed through the choroid, without firstcauterizing it, through the RPE, and then into the subretinal spacecontaining the SRF. This procedure typically is performed under directvisualization while using a binocular indirect ophthalmoscope (or BIO)to look directly into the eye. One disadvantage of this more recentlyadopted procedure is that hemorrhage from the choroid occurs because,unlike in the older procedure, the choroid is not cauterized. In anattempt to prevent this complication, some surgeons elevate theintraocular pressure by tightening a scleral buckle (i.e., a belt-likeor tourniquet-like device) encircled around the eye or a portion of theeye to tamponade the choroid (i.e., increase the pressure on thechoroid). Although this modification may decrease the occurrence ofhemorrhage from the choroid, it does not significantly minimize oreliminate it. Thus, even when using the foregoing modified procedure,hemorrhage typically still occurs, and sometimes is severe. Sincesubretinal blood can be very toxic to the retina, hemorrhage may resultin markedly decreased vision, thus, limiting or defeating the effects ofthe retinal surgery.

Based on the foregoing, it should be appreciated that there is a needfor improved apparatuses and methods that address these and/or otherperceived shortcomings of the prior art. For example, there is a needfor apparatuses and methods for subretinal fluid drainage thatsignificantly minimize or eliminate the occurrence of hemorrhage whileeliminating the need to perform a sclerotomy, thereby reducing the timefor surgery, and also permitting the viewing of the subretinal fluiddrainage under direct observation with a binocular indirectophthalmoscope.

SUMMARY OF THE INVENTION

The present invention provides apparatuses and methods for transcleralcautery and subretinal drainage.

Briefly described, one embodiment of the apparatus, among others,includes a barrel section. A needle section extends from the barrelsection. Additionally, a scleral depressor section at least partiallysurrounds an intermediate portion of the needle section.

Another embodiment of the apparatus includes an inner barrel section andan outer barrel section. An inner needle section extends from the innerbarrel section, and an outer needle section extends from the outerbarrel section. Additionally, a scleral depressor section at leastpartially surrounds an intermediate portion of the outer needle section.The outer needle section and the outer barrel section are adapted toreceive the inner needle section and the inner barrel section thereinsuch that the distal end of the inner needle section can be withdrawninside of the outer needle section and at least partially extendedoutside of the outer needle section.

The present invention can also be viewed as providing a method fortranscleral cautery and subretinal drainage. In this regard, oneembodiment of such a method, among others, can be broadly summarized bythe following steps: providing an apparatus for use with an eye thatincludes a barrel section, a needle section, a scleral depressorsection, and a cautery section, inserting the needle section into thesclera and choroid of the eye, cauterizing the choroid of the eye withthe cautery section, further inserting the needle section into theretinal pigment epithelium and the subretinal space of the eye, anddraining at least part of the subretinal fluid contained in the eye intothe needle section.

Another embodiment of the method can be broadly summarized by thefollowing steps: providing an apparatus for use with an eye thatincludes an inner barrel section, an inner needle section, an outerbarrel section, an outer needle section, a scleral depressor section,and a cautery section, inserting the outer needle section into thesclera and choroid of the eye, cauterizing the choroid of the eye withthe cautery section, inserting the inner needle section into the retinalpigment epithelium and the subretinal space of the eye, and draining atleast part of the subretinal fluid contained in the eye into the innerneedle section.

Other apparatuses, methods, features, and advantages of the presentinvention will be or become apparent to one with skill in the art uponexamination of the following drawings and detailed description. It isintended that all such additional apparatuses, methods, features, andadvantages be included within this description, be within the scope ofthe present invention, and be protected by the accompanying claims.

BRIEF DESCRIPTION OF THE DRAWINGS

Many aspects of the invention can be better understood with reference tothe following drawings. The components in the drawings are notnecessarily to scale, emphasis instead being placed upon clearlyillustrating the principles of the present invention. Moreover, in thedrawings, like reference numerals designate corresponding partsthroughout the several views.

FIG. 1A is a perspective view of an embodiment of a single barrel/singleneedle transcleral cautery/subretinal drainage apparatus of the presentinvention.

FIG. 1B is a front view of an embodiment of a single barrel/singleneedle transcleral cautery/subretinal drainage apparatus of the presentinvention.

FIG. 1C is a side view of an embodiment of a single barrel/single needletranscleral cautery/subretinal drainage apparatus of the presentinvention.

FIG. 1D is a bottom view of an embodiment of a single barrel/singleneedle transcleral cautery/subretinal drainage apparatus of the presentinvention.

FIG. 2A is a perspective view of an embodiment of a two barrel/twoneedle transcleral cautery/subretinal drainage apparatus of the presentinvention.

FIG. 2B is a front view of an embodiment of a two barrel/two needletranscleral cautery/subretinal drainage apparatus of the presentinvention.

FIG. 2C is a side view of an embodiment of a two barrel/two needletranscleral cautery/subretinal drainage apparatus of the presentinvention.

FIG. 2D is a bottom view of an embodiment of a two barrel/two needletranscleral cautery/subretinal drainage apparatus of the presentinvention.

FIG. 3A shows an embodiment of a single barrel/single needle transcleralcautery/subretinal drainage apparatus of the present invention partiallyinserted into an eye section.

FIG. 3B shows an embodiment of a single barrel/single needle transcleralcautery/subretinal drainage apparatus of the present invention fullyinserted into an eye section.

FIG. 4A shows an embodiment of a two barrel/two needle transcleralcautery/subretinal drainage apparatus of the present invention partiallyinserted into an eye section.

FIG. 4B shows an embodiment of a two barrel/two needle transcleralcautery/subretinal drainage apparatus of the present invention fullyinserted into an eye section.

DETAILED DESCRIPTION

Having summarized the invention above, reference is now made in detailto the figures which depict exemplary embodiments of the invention.Generally, the invention provides apparatuses and methods for theperformance of transcleral cautery and subretinal drainage. Referring toFIGS. 1A–1D, an embodiment of a single barrel/single needle transcleralcautery/subretinal drainage apparatus 100 (hereafter, the “single barrelapparatus”) is shown.

The single barrel apparatus 100 includes a barrel section 102 that isconnected to a needle section 104. Typically, although not exclusively,both the barrel section 102 and the needle section 104 are substantiallycylindrical in shape. Further, the needle section 104 typically has asubstantially smaller diameter than the diameter of the barrel section102, as depicted, for example, in FIGS. 1A–D. The barrel section 102 mayinclude a transition section 106 that transitions in diameter fromsubstantially the diameter of the barrel section 102 to substantiallythe diameter of the needle section 104 such that fluid or other materialmay be transferred from the needle section 104 to the barrel section 102and/or the converse.

Typically, the barrel section 102, including the transition section 106,is constructed of a glass or plastic material, but other materials maybe used within the scope of the invention. The needle section 104 istypically constructed of a metal, such as stainless steel or aluminum,but the needle section 104 may also be constructed of other materialswithin the scope of the invention.

As depicted in the various views of the single barrel apparatus 100shown in FIGS. 1A–1D, both the barrel section 102 and the needle section104 define an interior volume. The interior volume of each section isadapted to contain fluid or other material. In some embodiments, the endof the barrel section 102 opposite the needle section 104 may be closedoff or sealed. In other embodiments, the barrel section 102 may includean opening at the end opposite the needle section 104, and this openingmay exhibit a diameter that is larger, smaller, or substantially thesame as the diameter of the barrel section 102. In such embodiments, theopening of the barrel section 102 may be connected to some othercomponent (not shown), for example a flexible tubing. Such othercomponent may serve the purpose, for example, of conveying fluid orother material into or out of the barrel section 102.

The needle section 104 includes an opening at the distal end (i.e., theend opposite the barrel section 102). This opening is typicallysubstantially the same diameter as the diameter of the needle section104, but may be larger or smaller in diameter than that of the needlesection 104. The opening of the needle section 104 is adapted to acceptor discharge fluid or other material, particularly in the performance ofeye surgery. The opening of the needle section 104 is typically alsoadapted to cut or pierce organic tissues, such as scleral, choroidal,and retinal tissue of an eye. For example, the opening may be shaped andfurther adapted such that it exhibits a sharp end surface. A typicalouter diameter for the needle section 104 is 1.0 mm, although otherdiameters may be implemented within the scope of the invention.

The single barrel apparatus includes additional features that make ituseful for the above mentioned cautery and drainage functions. In thatregard, the single barrel apparatus 100 may further include a scleraldepressor section 108 and/or a cautery section 110. The scleraldepressor section 108 is typically substantially circular and has alarger diameter than that of the needle section 104. The scleraldepressor section 108 is typically composed of a material that issubstantially non-conductive of heat and/or electrical current. Forexample, the scleral depressor section 108 may be composed of a glass,aluminum, or plastic material that possesses the foregoingcharacteristics. The scleral depressor section 108 at least partiallysurrounds the needle section 104 and is typically securely affixed tothe needle section 104. Some embodiments of the single barrel apparatus100 may not include the scleral depressor section 108.

The cautery section 110 is typically located at the distal portion ofthe needle section 104 beyond the scleral depressor section 108, asdepicted, for example, in FIGS. 1A–1C. Typically, although notexclusively, the distance from the distal end (i.e., the opening) of theneedle section 104 to the scleral depressor section 108 is 1.5 mm andthe radial distance from the outer surface of the needle section 104 tothe outer edge of the scleral depressor section 108 is 2.5 mm.

The cautery section 110 is adapted to cauterize tissue or other materialthat it contacts. The cautery section 110 is typically heated by energysupplied from an energy supplying device 150 as depicted in FIG. 1A,such as a cautery machine. Typically, only the cautery section 110 isheated while the other portions of the needle section 104 maintain alower or substantially ambient temperature as a result of, for example,the temperature gradient characteristics of the needle section 104 orthe other portions being substantially insulated from heating.

Heating of the cautery section 110 may be accomplished in various ways.For example, as shown in FIG. 1A, one or more energy carrying conductors152, such as insulated wires, may carry energy from the energy supplyingdevice 150 to an attachment point 154 on the barrel section 102. Fromsuch connection point 154 to the cautery section 110, insulation orsheathing 156 may be provided around the conductors 152 to consolidatethe conductors 152 and prevent heating of sections other than thecautery section 110. The conductors 152 are connected to the cauterysection 110 at a termination point 158. The termination point 158 may beaccomplished in various ways so that energy supplied from the energysupplying device 150 causes the heating of the cautery section 110. Forexample, a portion of the conductors 152 may be soldered to or wrappedaround a portion of the cautery section 110. Other variations anddevices may be implemented to heat the cautery section 110 and areconsidered to be within the scope of the present invention.

Referring now to FIGS. 2A–2D, an embodiment of a two barrel/two needletranscleral cautery/subretinal drainage apparatus 200 (hereafter, the“two barrel apparatus”) is shown. The two barrel apparatus 200 includesseveral components. There is an outer barrel section 202 that isconnected to an outer needle section 204. The outer barrel section 202and the outer needle section 204 are typically, although notexclusively, substantially cylindrical in shape. Further, as depicted inFIGS. 2A–2D, the diameter of the outer barrel section 202 is typicallylarger than the diameter of the outer needle section 204. Accordingly,the outer barrel section 202 may include an outer transition section 206that transitions in diameter from substantially the diameter of theouter barrel section 202 to substantially the diameter of the outerneedle section 204 such that fluid or other material may be transferredfrom the outer needle section 204 to the outer barrel section 202 and/orthe converse.

The outer barrel section 202, including the outer transition section206, is typically constructed of a glass or plastic material, but othermaterials may be applied within the scope of the invention. The outerneedle section 204 is typically constructed of a metal, such asstainless steel or aluminum, but the outer needle section 204 mayalternatively be constructed of other materials within the scope of theinvention.

Both the outer barrel section 202 and the outer needle section 204define an interior volume as depicted, for example, in the various viewsof the two barrel apparatus 200 shown in FIGS. 2A–2D. In someembodiments, the outer barrel section 202 may be closed off or sealed atthe end opposite the outer needle section 204 In other embodiments, theouter barrel section 202 may include an opening at the end opposite theouter needle section 204, and this opening may exhibit a diameter thatis larger, smaller, or substantially the same as the diameter of theouter barrel section 202.

The outer needle section 204 includes an opening at the distal end(i.e., the end opposite the outer barrel section 202) as depicted, forexample, in the various views of the two barrel apparatus 200 shown inFIGS. 2A–2D. This opening is typically substantially the same diameteras the diameter of the outer needle section 204, but may be larger orsmaller in diameter than that of the outer needle section 204. Theopening of the outer needle section 204 is typically also adapted to cutor pierce organic tissues, such as scleral, choroidal, and retinaltissue of an eye. For example, the opening may be shaped and furtheradapted such that it exhibits a sharp end surface. A typical outerdiameter for the outer needle section 204 is 1.0 mm, although otherdiameters may be implemented within the scope of the invention.

The two barrel apparatus 200 may also include a scleral depressorsection 208 and a cautery section 210. The scleral depressor section 208is typically substantially circular and has a larger diameter than thatof the outer needle section 204. The scleral depressor section 208 istypically composed of a material that is substantially non-conductive ofheat and/or electrical current. For example, the scleral depressorsection 208 may be composed of a glass, aluminum, or plastic materialthat possesses the foregoing characteristics. The scleral depressorsection 208 at least partially surrounds the outer needle section 204and is typically securely affixed to the outer needle section 204. Someembodiments of the two barrel apparatus 200 may not include the scleraldepressor section 208.

The cautery section 210, as depicted for example in FIGS. 2A–2D, istypically located at the distal portion of the outer needle section 204beyond the scleral depressor section 208. Typically, although notexclusively, the distance from the distal end (i.e., the opening) of theouter needle section 204 to the scleral depressor section 208 is 1.5 mmand the radial distance from the outer surface of the outer needlesection 204 to the outer edge of the scleral depressor section 208 is2.5 mm.

The cautery section 210 is adapted to cauterize tissue or other materialthat it contacts. The cautery section 210 is typically heated by energysupplied from an energy supplying device 250 as depicted in FIG. 2A,such as a cautery machine. Typically, only the cautery section 210 isheated while the other portions of the outer needle section 204 maintaina lower or substantially ambient temperature as a result of, forexample, the temperature gradient characteristics of the outer needlesection 204 or the other portions being substantially insulated fromheating.

Heating of the cautery section 210 may be accomplished in various ways.For example, as shown in FIG. 2A, one or more energy carrying conductors252, such as insulated wires, may carry energy from the energy supplyingdevice 250 to an attachment point 254 on the outer barrel section 202.From such connection point 254 to the cautery section 210, insulation orsheathing 256 may be provided around the conductors 252 to consolidatethe conductors 252 and prevent heating of sections other than thecautery section 210. The conductors 252 are connected to the cauterysection 210 at a termination point 258. The termination point 258 may beaccomplished in various ways so that energy supplied from the energysupplying device 250 causes the heating of the cautery section 210. Forexample, a portion of the conductors 252 may be soldered to or wrappedaround a portion of the cautery section 210. Other variations anddevices may be implemented to heat the cautery section 210 and areconsidered to be within the scope of the present invention.

As discussed above, the outer barrel section 202 and the outer needlesection 204 each define an interior volume. The interior volume of eachsection is adapted to receive and contain an inner barrel section 212that is connected to an inner needle section 214. Typically, althoughnot exclusively, the inner barrel section 212 and the inner needlesection 214 are substantially cylindrical in shape. As depicted in FIGS.2A–2D, the inner barrel section 212 typically has a larger diameter thanthe inner needle section 214. Further, the inner barrel section 212 mayinclude an inner transition section 216 that transitions in diameterfrom substantially the diameter of the inner barrel section 212 tosubstantially the diameter of the inner needle section 214 such thatfluid or other material may be transferred from the inner needle section214 to the inner barrel section 212 and/or the converse.

The inner barrel section 212, including the inner transition section216, is typically constructed of a glass or plastic material, but othermaterials may be applied within the scope of the invention. The innerneedle section 214 is typically constructed of a metal, such asstainless steel or aluminum, but the inner needle section 214 mayalternatively be constructed of other materials within the scope of theinvention.

The diameters and overall dimensions of the inner barrel section 212 andthe inner needle section 214 are such that these sections can be atleast partially received within the outer barrel section 202 and theouter needle section 204 as depicted, for example, in FIGS. 2A–2D. Thus,in a typical configuration of the two barrel apparatus 204, the innerbarrel section 202 is received within the outer barrel section 212 andthe inner needle section 214 is received within the outer needle section204. Further, the outer barrel section 202 and the outer needle section204 are adapted to facilitate movement of the inner barrel section 212and the inner needle section 214 such that the inner needle section 214can be varied in position from being partially extended outside of theouter needle section 204 to being partially withdrawn within the outerbarrel section 202. The positioning of the inner needle section 214 whenit is partially withdrawn within the outer barrel section 202 is suchthat the heating of the cautery section 210 does not cause anysubstantial heating of the inner needle section 214 and the inner needlesection 214 does not extend out of the opening of the outer needlesection 204.

To further facilitate the movement of the inner barrel section 212 andinner needle section 214 within the outer barrel section 202 and theouter needle section 204, the outer barrel 204 may have a side opening218, such as a slot. The inner barrel section 212 may be configured suchthat a portion of it protrudes out of the side opening 218 when theinner barrel section 212 is received within the outer barrel section202, and this protruding portion 220 can be manipulated to move thecombined structure of the inner barrel section 212 and inner needlesection 214 within the combined structure of the outer barrel section202 and the outer needle section 204. In some embodiments, theprotruding portion 220 of the inner barrel section 212 may be a knob orother element attached to the side of the inner barrel section 212.

Another feature that the two barrel apparatus 200 may include tofacilitate the movement of the combined structure of the inner barrelsection 212 and inner needle section 214 within the combined structureof the outer barrel section 202 and outer needle section 204 is anelastic compressible element 222, such as a normally decompressedhelical spring. As depicted for example in FIGS. 2A–2C, the elasticcompressible element 222 is typically positioned such that one end ofthe elastic compressible element 222 rests against an interior portionof the outer barrel section 212, for example, at the outer transactionsection 206. The other end of the elastic compressible element 222typically rests against an exterior portion of the inner barrel section212, for example, at the inner transition section 216. Further, asdepicted in FIGS. 2A–2C, the elastic compressible element 222 maypartially surround or encircle the inner needle section 214. Asdescribed in this embodiment, the elastic compressible element 222serves to retract and maintain the combined structure of the innerbarrel section 212 and inner needle section 214 in a fully withdrawnposition within the combined structure of the outer barrel section 202and outer needle section 204.

Focusing in further detail on the inner barrel section 212 and the innerneedle section 214 of the two barrel apparatus 200, in some embodiments,the end of the inner barrel section 212 opposite the inner needlesection 214 may be closed off or sealed. In other embodiments, the innerbarrel section 212 may include an opening at the end opposite the innerneedle section 214. This opening may exhibit a diameter that is larger,smaller, or substantially the same as the diameter of the inner barrelsection 212. In such embodiments, the opening of the inner barrelsection 212 may be connected to some other component (not shown), forexample a flexible tubing, that may serve the purpose, for example, ofconveying fluid or other material into or out of the inner barrelsection 212.

The inner needle section 214, as depicted in the various views of thetwo barrel apparatus 200 shown in FIGS. 2A–2D, includes an opening atthe end opposite the inner barrel section 212. This opening is typicallysubstantially the same diameter as the diameter of the inner needlesection 214, but may be larger or smaller in diameter than that of theinner needle section 214 as well. The opening of the inner needlesection 214 is adapted to accept or discharge fluid or other material,particularly in the performance of eye surgery. The opening of the innerneedle section 214 is typically also adapted to cut or pierce organictissues, such as scleral, choroidal, and retinal tissue of an eye. Forexample, the opening may be shaped and further adapted such that itexhibits a sharp end surface.

Having discussed several apparatus embodiments of the present invention,discussion is now focused on several related method embodiments.Although descriptions of various embodiments are presented hereafterwith respect to surgery on a human eye, the application of theembodiments to other types of eyes is not excluded from being within thescope of the invention. In this regard, a method for performingtranscleral cautery and subretinal drainage using, for example, thesingle barrel apparatus 100 in accordance with an embodiment of thepresent invention is described hereafter.

FIGS. 3A–3B depict the single barrel apparatus 100 inserted into an eyesection 302 of a human eye to perform transcleral cautery and subretinaldrainage. The features of the single barrel apparatus 100 were describedabove with respect to FIGS. 1A–1D. In FIGS. 3A–3B, the eye section 302of the eye includes several sections that are relevant to thisdescription. The sclera 304 is the outermost section of the eye withrespect to this discussion. As is known, a typical thickness of thesclera 304 is approximately 0.45 mm to 1.3 mm with a thickness ofapproximately 1.1 mm at the equator. Below (i.e., inside of) the sclera304 is the choroid 306. The choroid 306 has a typical thickness ofapproximately 0.2 mm. Below (i.e., inside of) the choroid 306 is theretinal pigment epithelium (“RPE”) 308, and below (i.e., inside of) theRPE 308 is the subretinal space 310 which will contain subretinal fluid(“SRF”) 312 when, for example, there is a retinal detachment conditionof the eye.

FIG. 3A depicts the typical positioning of the single barrel apparatus100 to perform transcleral cautery (which includes cautery of thechoroid 306). In that regard, the needle section 104 is inserted intothe eye section 302 such that it penetrates the sclera 304 and thechoroid 306 with the cautery section 110 of the needle section 104 beingpositioned in contact with the choroid 306. During such insertion of theneedle section 104, the scleral depressor section 108 may contact thesclera 304. With the needle section 104 placed in the foregoing positionwith respect to the eye section 302, transcleral cautery may beperformed by heating the cautery section 110 of the needle section 104appropriately. Such heating may be controlled for example, by varyingthe energy supplied to the cautery section 110 from an energy supplyingdevice such as a cautery machine (not shown).

FIG. 3B depicts the typical positioning of the single barrel apparatus100 to perform drainage of subretinal fluid 312. In that regard, theneedle section 104 is inserted into the eye section 302 such that itpenetrates through the sclera 304, the choroid 306, the RPE 308, andinto the subretinal space 310 so that the opening of the needle section104 is exposed to the subretinal fluid 312 and the subretinal fluid 312may pass into the needle section 104 and subsequently into the barrelsection 102 of the single barrel apparatus 100. During such insertion ofthe needle section 104, the scleral depressor section 108 may contactthe sclera 304. The scleral depressor section 108 may also serve tolimit the insertion depth of the needle section 104 into the eye section302.

To facilitate the accurate insertion and positioning of the singlebarrel apparatus 100 into the eye section 302, direct visualization intothe eye may be performed using a binocular indirect ophthalmoscope.Typically, the scleral depressor section 108 is used prior to theinitial insertion of the needle section 104 into the eye section 302 todepress the sclera 304 such that a surgeon using a binocular indirectophthalmoscope can determine an optimal insertion point of the needlesection 104 into the eye section 302. The drainage of subretinal fluid312 into the needle section 104 and subsequently into the barrel section102 typically is accomplished as a result of positive pressure of theeye and capillary action. Pressure applied to the eye as a result of thecontact of the sclera 304 by, for example, the scleral depressor section108, a scleral buckle, and/or a cotton tipped applicator may furtherfacilitate the drainage of subretinal fluid 312 into the needle section104.

While performing a surgical procedure using the single barrel apparatus100, the steps of penetrating the eye section 302, cauterizing thechoroid 306, and draining subretinal fluid 312 may each be performedrepeatedly as needed in order to facilitate the surgery.

In accordance with another embodiment of the present invention, a methodis now described for performing transcleral cautery and subretinaldrainage using, for example, the two barrel apparatus 200. In thatregard, FIGS. 4A–4B depict the two barrel apparatus 200 inserted into aneye section 302 of a human eye to perform transcleral cautery andsubretinal drainage. The features of the two barrel apparatus 200 weredescribed in detail above with respect to FIGS. 2A–2D. In FIGS. 4A–4B,the eye section 302 has the same features as described above withrespect to FIG. 3. Thus, the eye section 302 in FIGS. 4A–4B has a sclera304, choroid 306, RPE 308, subretinal space 310, and subretinal fluid312, as depicted.

FIG. 4A depicts the typical positioning of the two barrel apparatus 200to perform transcleral cautery (which includes cautery of the choroid306). In that regard, the outer needle section 204 is inserted into theeye section 302 such that it penetrates the sclera 304 and the choroid306 with the cautery section 210 of the needle section 204 beingpositioned in contact with the choroid 306. During such insertion of theouter needle section 204, the scleral depressor section 208 may contactthe sclera 304. The scleral depressor section 208 may also serve tolimit the insertion depth of the outer needle section 204 into the eyesection 302.

With the outer needle section 204 placed in the foregoing position withrespect to the eye section 302, transcleral cautery may be performed byheating the cautery section 210 of the outer needle section 204appropriately. Such heating may be controlled for example, by varyingthe energy supplied to the cautery section 210 from an energy supplyingdevice such as a cautery machine.

During the performance of transcleral cautery as described in theforegoing, the combined structure of the inner barrel section 212 andinner needle section 214 may be received within the combined structureof the outer barrel section 202 and outer needle section 204 such thatthe inner needle section 214 is at least partially withdrawn into theouter needle section 204, as shown for example in FIG. 4A. In suchposition, the heating of the cautery section 210 does not cause anysubstantial heating of the inner needle section 214 and the inner needlesection 214 does not extend out of the opening of the outer needlesection 204. Alternatively, in some embodiments, the combined structureof the inner barrel section 212 and inner needle section 214 may becompletely withdrawn outside of the combined structure of the outerbarrel section 202 and the outer needle section 204 during theperformance of transcleral cautery.

FIG. 4B depicts the typical positioning of the two barrel apparatus 200to perform drainage of subretinal fluid 312. In that regard, thecombined structure of the outer barrel section 202 and outer needlesection 204 are positioned the same as for the performance oftranscleral cautery. Thus, drainage of subretinal fluid 312 can beperformed with the two barrel apparatus 200 in the same position thattranscleral cautery (including cautery of the choroid 306) can beperformed with the two barrel apparatus 200. Therefore, as depicted inFIG. 4B, the outer needle section 204 is inserted into the eye section302 such that it penetrates the sclera 304 and the choroid 306 with thecautery section 210 of the outer needle section 204 being positioned incontact with the choroid 306. Further, during such insertion of theouter needle section 204, the scleral depressor section 208 may contactthe sclera 304.

With the outer needle section 204 placed in the foregoing position withrespect to the eye section 302, the combined structure of the innerbarrel section 212 and inner needle section 214 are received within thecombined structure of the outer barrel section 202 and outer needlesection 204, as depicted in FIG. 4B, in order to perform drainage of thesubretinal fluid 312. In that regard, the combined structure of theinner barrel section 212 and inner needle section 214 are positionedsuch that the inner needle section 214 extends partially out of theopening of the outer needle section 204 and penetrates through the RPE308 and into the subretinal space 310, as depicted in FIG. 4B. In suchposition, the opening of the inner needle section 214 is exposed to thesubretinal fluid 312 and the subretinal fluid 312 may pass into theinner needle section 214 and subsequently into the inner barrel section212 of the two barrel apparatus 200.

To facilitate the accurate insertion and positioning of the two barrelapparatus 200 into the eye section 302, direct visualization into theeye may be performed using a binocular indirect ophthalmoscope.Typically, the scleral depressor section 208 is used prior to theinitial insertion of the outer needle section 204 into the eye section302 to depress the sclera 304 such that a surgeon using a binocularindirect ophthalmoscope can determine an optimal insertion point of theouter needle section 204 into the eye section 302. The drainage ofsubretinal fluid 312 into the inner needle section 204 and subsequentlyinto the inner barrel section 202 typically is accomplished as a resultof positive pressure of the eye and capillary action. Pressure appliedto the eye as a result of the contact of the sclera 304 by, for example,the scleral depressor section 208, a scleral buckle, and/or a cottontipped applicator may further facilitate the drainage of subretinalfluid 312 into the inner needle section 214.

While performing a surgical procedure using the two barrel apparatus200, the outer needle section 204 can be positioned in the eye section302 as described above and maintained in that position to performtranscleral cautery as needed. While the outer needle section 204 isinserted appropriately into the eye section 302, the inner needlesection 214 can be inserted into and retracted out of the subretinalspace 310 in order to perform drainage of subretinal fluid 312 asneeded. In that regard, the protruding portion 220 of the inner barrelsection 212 (described above with respect to FIGS. 2A–2D) may facilitatethe insertion and retraction of the inner needle section 214 from thesubretinal space 310 and the RPE 308. For example, a surgeon mayposition his finger, thumb, etc. on the protruding portion 220 in amanner to cause the inner needle section 214 to be inserted or retractedfrom the subretinal space 310 and the RPE 308.

Additionally, or alternatively, the elastic compressible element 222(described above with respect to FIGS. 2A–2D) may also facilitate theinsertion and/or retraction of the inner needle section 214 from thesubretinal space 310 and the RPE 308. For example, with the elasticcompressible element 222 positioned, for example, as shown in FIGS.4A–4B, the inner needle section 214 will be retracted from thesubretinal space 310 and the RPE 308 when no force is applied, forexample to the protruding portion 220 of the inner barrel section 202,to cause the inner needle section 214 to insert into the RPE 308 and thesubretinal space 310.

The single barrel apparatus 100 and the two barrel apparatus 200,described in the foregoing, may be implemented to facilitate theperformance of various types of eye surgery. For example, the singlebarrel apparatus 100 and the two barrel apparatus 200 may each be usedto perform transcleral cautery and subretinal fluid drainage tofacilitate traditional scleral buckle surgery or pneumatic retinopexy.

It should be emphasized that the above-described embodiments of thepresent invention are merely possible examples of implementations merelyset forth for a clear understanding of the principles of the invention.Many variations and modifications may be made to the above-describedembodiments of the invention without departing substantially from thespirit and principles of the invention. All such modifications andvariations are intended to be included herein within the scope of thisdisclosure and the present invention and protected by the followingclaims.

1. An apparatus for use with an eye having a sclera, a choroid, andsubretinal fluid, said apparatus comprising: a barrel section having afirst wall configured to define a first interior volume and adapted toretain fluid therein; a needle section, extending from said barrelsection, having a second wall defining a second interior volume andadapted to retain fluid therein, said needle section being in fluidiccommunication with said barrel section such that the subretinal fluid ofan eye is retained within and flows between said needle section and saidbarrel section when the subretinal fluid of said eye is drained intosaid needle section; a cautery section of said needle section; a scleraldepressor section at least partially surrounding an intermediate portionof said needle section and adapted to engage and depress the sclera ofsaid eye; and an energy supplying device configured to supply energy tosaid cautery section such that said cautery section is heated forcauterizing the choroid of the eye.
 2. The apparatus of claim 1, whereinthe cautery section of said needle section is between said scleraldepressor section and the distal end of said needle section, saidcautery section being adapted to cauterize the choroid of said eye. 3.The apparatus of claim 1, wherein said barrel section and said needlesection are cylindrically shaped and said scleral depressor section isannularly shaped.
 4. The apparatus of claim 1, further comprising asecond barrel section having a first outer wall configured to define athird interior volume.
 5. The apparatus of claim 4, further comprisingan outer needle section, extending from said outer barrel section,having a second outer wall defining a fourth interior volume, said outerneedle section and said outer barrel section being adapted to receivesaid inner needle section and said inner barrel section therein suchthat the distal end of said inner needle section can be withdrawn insideof said outer needle section and at least partially extended outside ofsaid outer needle section.
 6. The apparatus of claim 5, wherein thecautery section is configured between said scleral depressor section andthe distal end of said outer needle section.
 7. The apparatus of claim5, further comprising a protruding section protruding at least partiallyalong the length of said inner barrel section, and wherein said outerwall has a longitudinal opening extending at least partially along thelength of said outer barrel section such that said protruding sectionprotrudes through said longitudinal opening when said inner barrelsection is received within said outer barrel section, said longitudinalopening being adapted such that said protruding section is slideablyengageable to cause said inner needle section to move fully inside ofsaid outer needle section and at least partially outside of said outerneedle section.
 8. The apparatus of claim 7, further comprising anelastic compressible element positioned within said outer barrel sectionand engaging between the interior of said outer barrel section and theexterior of said inner barrel section such that said elasticcompressible element causes said inner needle section to be at leastpartially withdrawn inside of said outer needle section when saidprotruding section is not slideably engaged.
 9. The apparatus of claim8, wherein said elastic compressible element is a normally decompressedhelical spring.
 10. The apparatus of claim 5, wherein said inner barrelsection, said outer barrel section, said inner needle section, and saidouter needle section are cylindrically shaped and said scleral depressorsection is annularly shaped.
 11. An apparatus for use with an eye havinga sclera, a choroid, and subretinal fluid, said apparatus comprising: abarrel section having a first wall configured to define a first interiorvolume and adapted to retain fluid therein; a needle section, extendingfrom said barrel section, having a second wall defining a secondinterior volume and adapted to retain fluid therein, said needle sectionbeing in fluidic communication with said barrel section such that thesubretinal fluid of an eye is retained within and flows between saidneedle section and said barrel section when the subretinal fluid of saideye is drained into said needle section; a scleral depressor sectionproximate to a distal end of the needle section, adapted to engage anddepress the sclera of said eye; a cautery section of said needlesection; and an energy supplying device configured to supply energy tosaid cautery section such that said cautery section is heated forcauterizing the choroid of the eye.
 12. The apparatus of claim 11,wherein the scleral depressor section partially surrounds anintermediate portion of said needle section.
 13. The apparatus of claim11, wherein the scleral depressor section is annularly shaped.
 14. Theapparatus of claim 11, wherein said cautery section is between saidscleral depressor section and a distal end of said needle section. 15.The apparatus of claim 14, wherein said cautery section is adapted tocauterize the choroid of said eye.